The main goal of treating a patient with dizziness is the most complete elimination of unpleasant sensations and accompanying neurological and otiatric disorders (impaired coordination, hearing, vision, etc.). Therapeutic tactics are determined by the cause of the disease and the mechanisms of its development. Important goals are to ensure maximum independence in everyday life, minimize the risk of falls as a potential source of injury, and eliminate or reduce the likelihood of developing a traumatic situation for the patient.
Main directions dizziness treatment determined by its etiology.
- In case of cerebrovascular disorders, effective control of blood pressure, the use of nootropics, antiplatelet agents, vasodilators or venotonics, and, if necessary, antiepileptic drugs are required.
- Patients with Meniere’s disease are advised to limit their intake of table salt and use diuretics; in the absence of effect and frequent severe attacks of dizziness, surgical treatment is considered.
- Vestibular neuronitis may require the use of antiviral drugs.
- The basis of treatment for a patient with BPPV is non-drug therapy.
- The essence of the method is that the patient makes head movements that promote the displacement of otoliths from the semicircular canal to the vestibule. The Epley technique is considered the most effective manipulation. The patient is placed on the couch on his back with his head turned towards the affected labyrinth and slightly thrown back. The head is turned slowly (for 1 minute) in the opposite direction, which causes displacement of the otoliths. As the turn is carried out, a feeling of systemic dizziness arises, intensifying towards the end of its implementation. At the same time, the patient can detect horizontal or horizontal-rotatory binocular nystagmus. Intense dizziness may be associated with the displacement of otoliths into the elliptical sac, which is the purpose of the manipulation. While supporting the patient, you should sit him on the couch and perform the manipulation with his head turned in the opposite direction. Displaced otoliths can cause receptor irritation for several hours, which is accompanied by dizziness (iatrogenic instability of the otolithic apparatus). After repositioning the otoliths, it is advisable to remain in a position with the head raised for XNUMX hours.
- The use of drugs that inhibit the activity of the vestibular analyzer for benign paroxysmal positional vertigo is considered inappropriate.
Symptomatic treatment of dizziness
Symptomatic therapy for dizziness involves the use of vestibulolytics, which inhibit the activity of vestibular receptors and ascending conduction systems. The duration of their administration should not be excessively long, since some drugs, by inhibiting the activity of the corresponding nerve formations, prevent the development of compensatory changes. To relieve and prevent attacks of systemic dizziness, betahistine is widely used, the effect of which is realized through histamine H2- and H3-receptors of the inner ear and vestibular nuclei. The drug is usually prescribed at a dose of 48 mg per day (24 mg tablets – 2 times a day), the effectiveness increases with simultaneous therapeutic exercises. For non-systemic dizziness (balance disorders, presyncope, psychogenic dizziness), the use of betahistine as primary therapy is not advisable.
When the vestibular analyzer is predominantly affected, antihistamines – meclozine (12,5-25 mg 3-4 times a day), promethazine (25-50 mg 4 times a day) – have an effect.
Drugs that limit the entry of calcium ions into the cell are widely used, which in this situation have a variety of clinical effects (cinnarizine 25 mg 3 times a day).
Traditionally, combined drugs with vestibulolytic and sedative effects are widely used, helping to reduce the severity of both dizziness itself and accompanying vegetative manifestations. The composition of such drugs includes belladonna alkaloids, sedative, vasoactive components (for example, belladonna alkaloids + phenobarbital + ergotamine-bellataminal). The feasibility of their use has been established empirically; clinically significant effects include a decrease in nausea, hyperhidrosis, hypersalivation, and bradycardia, as a result of which episodes of dizziness are tolerated much more easily.
An extremely difficult problem is the management of patients with predominantly non-systemic dizziness, in particular, balance disorders. The therapeutic approach is determined by the nature of the leading pathological process (the degree and level of organic damage to the brain or spinal cord, disorders of proprioceptive afferentation, etc.). Non-drug therapy aimed at restoring coordination of movements, improving gait, and teaching the patient the skills to overcome balance disorders is of great importance. Often, non-pharmacological treatment is limited by concomitant cognitive decline.
In the vast majority of cases of dizziness, systematic physical therapy exercises are advisable, allowing not only to reduce subjective unpleasant manifestations, but also to ensure the maximum possible independence of the patient in everyday life, as well as reduce the risk of falls in the elderly.
It is advisable to treat patients with psychogenic dizziness with the participation of a psychotherapist (psychiatrist). Along with non-drug treatment, in most cases it is necessary to use antidepressants and anxiolytics. In some cases, a positive effect can be achieved by prescribing anticonvulsants (carbamazepine, gabapentin). It should be borne in mind that most of these drugs themselves in a certain situation (with inadequate dosage, rapid increase in dose) can cause dizziness. To avoid self-cessation of treatment, the patient must be informed about possible side effects.
In many patients with dizziness caused by organic damage to the vestibular apparatus or other sensory systems, recovery may be incomplete, and therefore rehabilitation methods aimed at compensating for the defect and providing the patient with a certain level of independence in everyday life acquire exceptional importance.